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Ankle pain

Pain - ankle

Ankle pain involves any discomfort in one or both ankles.

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Causes

Ankle pain is often due to an ankle sprain.

• An ankle sprain is an injury to the ligaments, which connect bones to one another.
• In most cases, the ankle is twisted inward, causing small tears in the ligaments. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.
• The ligament injuries are more common on the outside of your ankle but the inside ligaments can tear also.

In addition to ankle sprains, ankle pain can be caused by:

• Damage or swelling of tendons (which join muscles to bone) or cartilage (which cushions joints)
• Infection in the ankle joint
• Osteoarthritis, gout, rheumatoid arthritis, Reiter syndrome, and other types of arthritis

Problems in areas near the ankle that can cause you to feel pain in the ankle include:

• Blockage of blood vessels in the leg
• Heel pain or injuries
• Tendinitis around the ankle joint
• Nerve injuries (such as tarsal tunnel syndrome or sciatica)

Home Care

Home care for ankle pain depends on the cause and what other treatment or surgery has taken place. You may be asked to:

• Rest your ankle for several days. Try to NOT put much weight on your ankle.
• Put on an ACE bandage. You also can buy a brace that supports your ankle.
• Use crutches or a cane to help take the weight off a sore or unsteady ankle.
• Keep your foot raised above the level of your heart. When you are sitting or sleeping, place two pillows under your ankle.
• Ice the area right away. Apply ice for 10 to 15 minutes every hour for the first day. Then, apply ice every 3 to 4 hours for 2 more days.
• Try acetaminophen, ibuprofen, or other pain relievers made by the store.
• You may need a brace to support the ankle or a boot to rest your ankle.

As the swelling and pain improve, you may still need to keep extra weight and stress off your ankle for a period of time.

The injury may take a few weeks to many months to fully heal. Once the pain and swelling are mostly gone, the injured ankle will still be a little weaker and less stable than the uninjured ankle.

• You will need to start exercises to strengthen your ankle and avoid injury in the future.
• DO NOT begin these exercises until a health care professional tells you it is safe to start.
• You will also need to work on your balance and agility to avoid another injury or sprain.

Other advice your health care provider may give you include:

• Avoid putting on extra weight since this could increase strain on your ankles.
• Warm up before exercising. Stretch the muscles and tendons that support the ankle.
• Avoid sports and activities for which you are not properly conditioned.
• Make sure that shoes fit you properly. Avoid high-heeled shoes.
• If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air casts, ACE bandages, or lace-up ankle supports.
• Work on your balance and do agility exercises.

When to Contact a Medical Professional

Go to the hospital if:

• You have severe pain even when you are NOT bearing weight.
• You suspect a broken bone (the joint looks deformed or you cannot put any weight on the leg).
• You can hear a popping sound and have immediate pain in the joint.
• You can't move your ankle back and forth.

Contact your provider if:

• Swelling does not go down within 2 to 3 days.
• You have symptoms of infection. The area becomes red, more painful, or warm, or you have a fever over 100°F (37.7°C).
• The pain does not go away after several weeks.
• Other joints are also involved.
• You have a history of arthritis and are having new symptoms.

References

Chiodo CP, Price MD, Sangeorzan AP. Foot and ankle pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzsky GA, McInnes IB, O'Dell JR, eds. Firestein and Kelly's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 52.

Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 118.

Osborne MD, Esser SM. Chronic ankle instability. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 85.

Rose NGW, Green TJ. Ankle and foot injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 49.

Rothenburg P, Swanton E, Molloy A, Aiyer AA, Kaplan AR. Ligamentous injuries of the foot and ankle. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 117.

Review Date: 4/24/2023  

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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